The role of dissemination and implementation science in global breast cancer control programs: Frameworks, methods, and examples

Abstract

Global disparities in breast cancer outcomes are attributable to a sizable gap between evidence and practice in breast cancer control and management. Dissemination and implementation science (D&IS) seeks to understand how to promote the systematic uptake of evidence-based interventions and/or practices into real-world contexts. D&IS methods are useful for selecting strategies to implement evidence-based interventions, adapting their implementation to new settings, and evaluating the implementation process as well as its outcomes to determine success and failure, and adjust accordingly. Process models, explanatory theories, and evaluation frameworks are used in D&IS to develop implementation strategies, identify implementation outcomes, and design studies to evaluate these outcomes. In breast cancer control and management, research has been translated into evidence-based, resource-stratified guidelines by the Breast Health Global Initiative and others. D&IS should be leveraged to optimize the implementation of these guidelines, and other evidencebased interventions, into practice across the breast cancer care continuum, from optimizing public education to promoting early detection, increasing guideline-concordant clinical practice among providers, and analyzing and addressing barriers and facilitators in health care systems. Stakeholder engagement through processes such as co-creation is critical. In this article, the authors have provided a primer on the contribution of D&IS to phased implementation of global breast cancer control programs, provided 2 case examples of ongoing D&IS research projects in Tanzania, and concluded with recommendations for best practices for researchers undertaking this work. Cancer 2020;126:2394-2404.

The Breast Health Global Initiative 2018 Global Summit on Improving Breast Healthcare Through Resource‐Stratified Phased Implementation: Methods and overview

“…Dissemination and implementation science focuses on research surrounding the implementation of evidence‐based interventions for health care system strengthening across all levels of care, from the patient level, to health care providers, to organizations and policy makers 65 . A key component of dissemination and implementation science is the evaluation of the implementation context and process, and its effect on breast health care delivery, by using appropriate metrics and frameworks to assess implementation outcomes, such as reach, efficacy, adoption, and fidelity 66 . The underlying concept of implementation science, a relatively new field, is to determine how we get the things that work to the people who need them most by developing and implementing resource‐appropriate, effective, and evidence‐based interventions to improve women's access to timely, appropriate, and affordable breast cancer early detection, treatment, and palliative care.…”

“…The underlying concept of implementation science, a relatively new field, is to determine how we get the things that work to the people who need them most by developing and implementing resource‐appropriate, effective, and evidence‐based interventions to improve women's access to timely, appropriate, and affordable breast cancer early detection, treatment, and palliative care. Broad questions to consider while framing approaches to translate guidelines into practice include 66 : What strategies are effective for implementing evidence‐based practices, programs, or policies? How do contextual factors, such as health system frameworks and cultural barriers, influence implementation success or failure? How can those contextual factors be taken into consideration to adapt strategies that increase the likelihood of implementation success? …”

Situational analysis of breast health care systems: Why context matters

“…Implementation frameworks, theories, and models can help to explain how and why EBPs succeed or fail. An in‐depth discussion of implementation science as it pertains to the implementation of resource‐appropriate breast cancer management is provided by Rositch et al in this supplement 3 ; in this article, we discussed the “why and how” of assessing context, and how it informs the adaptation of guidelines in different settings.…”

Breast cancer treatment: A phased approach to implementation

“…The Breast Health Global Initiative (BHGI) developed an approach to devising resource‐adapted recommendations for the comprehensive management of breast cancer throughout the continuum of care 5 . Building on this previous work, BHGI now proposes a phased implementation strategy to create sustainable approaches adapting preexisting frameworks to improve patient care in limited‐resource settings 6,7 . Phased implementation applies evidence‐based strategies to address the existing disease burden and define sequentially implementable, scalable models to address the needs of the populations served.…”